HUGHP Plan Options - PCP Questions - Dependent(s) Out-of Area Coverage - Traveling Outside the HUGHP Service Area - Behavioral Health Services (mental health or substance abuse) - Medco Prescription Drug Benefits - HUGHP works with Blue Cross Blue Shield - Referrals - Fitness and Weight Loss Benefits - Additional Healthy HUGHP Discounts
HUGHP Plan Options
Q: What types of HUGHP plans are available?
A: HUGHP offers an HMO plan and a Point of Service (POS) plan.
- HUGHP HMO – (HMO stands for Health Maintenance Organization). You are required to select a primary care provider (PCP) who is in the HUGHP network. Your PCP will coordinate all your medical care and refer you to a specialist when necessary. Most office visits will have a small copayment.
- HUGHP POS –Provides the same level of coverage as the HUGHP HMO plan, but affords members the opportunity for greater flexibility to seek care. Your PCP will coordinate all of your care and refer you to a specialist when needed; these services will be covered as they are under the HMO plan. However, if you choose to arrange care without a referral, or choose a provider who does not participate in the HUGHP network, you will have higher out-of-pocket costs.
- You pay a $500 deductible per member in each calendar year ($2,000 family limit).
- After meeting your deductible, you pay 20% of the remaining covered charges. This is your co-insurance.
- Your out-of-network provider may bill you the difference between his/her charge for services and the amount that HUGHP POS pays for those particular services.
out-of-pocket maximum. Your co-insurance annual out-of-pocket maximum is $2,000 ($5,000 family limit). Keep in mind, the out-of-pocket maximum does not include amounts you pay toward your annual deductible. When you reach your out-of-pocket maximum, most covered services will be paid in full.
Q: Why is HUGHP less expensive?
A: HUGHP members receive care from primary care physicians who are part of either HUHS or an Atrius Health practice - all of which are multi-specialty group practices where there is a focus on providing high quality, coordinated care. All of these practices also have an electronic medical record which helps facilitate the management and coordination of care, which also helps to eliminate unnecessary tests and visits. As a result, the cost of care is lower under the HUGHP plan and the HUGHP members share in those savings through lower premiums.
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PCP Questions
Q: How can I find a HUGHP Network Primary Care Physician (PCP)?
A: When you join HUGHP, you and your family have the option to choose a Primary Care Provider (PCP) at any of our locations. Just go to HUGHP.harvard.edu and select “Members”. From there you would select “Find a Doctor”. Once you have selected a PCP, you must contact HUGHP Member Services by calling 617-495-2008 or emailing mservices@huhs.harvard.edu
Q: At what locations can I select my PCP?
A: In addition to the four campus locations of Harvard University Health Services, there are five medical group practices whose PCPs are in the HUGHP network. You may select a PCP from any of these groups:
- Harvard University Health Services
- Dedham Medical Associates
- Granite Medical
- Harvard Vanguard Medical Associates
- Southboro Medical Group
- South Shore Medical Center
Q: Why did HUGHP select these medical group practices?
A: HUGHP selected these groups for their group practice philosophy and excellence in the quality of care and service provided to their patients, values already established by the Harvard University Health Services (HUHS). All use an electronic medical record and offer the convenience of many onsite services as well as extended office hours and same day urgent care appointments.
Q: Do I need to notify HUGHP of my PCP selection?
A: Yes. Once you have selected a PCP, you must contact HUGHP Member Services by calling 617-495-2008 or emailing mservices@huhs.harvard.edu .
Q: May I select a PCP on line through the HUGHP or the BCBS website?
A: No. You must either call or email the HUGHP Member Services Department to officially select your PCP. DO NOT try to select your PCP through the BCBS “Self Service” link on their website as this will not be communicated to HUGHP and may cause considerable inconvenience to you as you try to get authorized care.
Q: If I am on a family plan, can my dependents and I have PCPs at different locations?
A: Yes. Each of you may select a different PCP at different medical group locations.
Q: Can I switch to another HUGHP PCP?
A: You can switch PCPs at any time. Simply contact HUGHP Member Services by calling 617.495.2008 or emailing mservices@huhs.harvard.edu to inform the Plan of the change.
Q: If I have POS can I select a non-network PCP?
A: Yes. If you choose a provider who does not participate in the HUGHP network, you will have higher out-of-pocket costs. Most of your care will be subject to an annual deductible and co-insurance.
- You pay a $500 deductible per member in each calendar year ($2,000 family limit).
- After meeting your deductible, you pay 20% of the remaining covered charges. This is your co-insurance.
- Your out-of-network provider may bill you the difference between his/her charge for services and the amount the HUGHP POS pays for those particular services.
You are protected by an out-of-pocket maximum. Your co-insurance annual out-of-pocket maximum is $2,000 ($5,000 family limit). Keep in mind, the out-of-pocket maximum does not include amounts you pay toward your annual deductible. When you reach your out-of-pocket maximum, most covered services will be paid in full.
Q: If I am currently insured by Harvard Pilgrim Health Care and I receive care at one of the five medical group practices in the HUGHP network, may I keep my PCP if I join HUGHP?
A: Yes. Your PCP and affiliation with that medical group practice will remain exactly as it has always been. Your insurance changes and the HUGHP benefits and coverage you receive will be administered by HUGHP and its partner, Blue Cross Blue Shield of Massachusetts.
Q: If I join HUGHP, may I use any of the Harvard University Health Services (HUHS) clinics?
A: Yes. You will need to pick a PCP who is located at any of the Harvard University Health Services locations, including Holyoke Center, the Law School, Business School and Longwood Medical Area. You can work anywhere on campus and still select a PCP at any of the locations (for example, you may pick at PCP at the Business School clinic even if you do not work there).
Q: Are there any advantages to having a PCP at HUHS?
A: Yes, if you select a PCP at HUHS, you have:
- Easy access to care (including primary, specialty and urgent care, x-rays, mammograms, physical therapy and lab services) during work hours.
- Access to 24 hour Urgent Care Services. Urgent care services are available 24 hours a day, 7 days a week, 365 days a year at our Holyoke Center location in Harvard Square.
- Validated Parking. Receive validated parking in the Holyoke Center garage when visiting HUHS for appointments and when filling prescriptions at the HUHS Pharmacy.
- 90-day Prescription Refill Discount at the HUHS Pharmacy. A discounted copayment applies for 90-day prescriptions filled at the HUHS Pharmacy in Holyoke Center (Note: Prescriptions must be written by an HUHS clinician).
- Payroll Deduction. A convenient way to pay for services, programs, and products at HUHS, including your medical appointments; prescription and over-the-counter pharmaceuticals at our HUHS Pharmacy; complementary therapies at our Center for Wellness; and more.
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Dependent(s) Out-of Area Coverage
Q: Can my child be enrolled in HUGHP if he or she is away at school?
A: Your child can be enrolled in HUGHP up to the age of 25 provided he or she is enrolled as a full-time student at an accredited educational institution. Once your child reaches the age of 19, you will be required to submit a Full-time Student Verification Form annually. The form is sent out in September and is due back by mid-October.
Enrolled full-time student dependents must follow all requirements of HUGHP even if they attend school outside the service area.
Q: What is my child’s coverage while away at school?
A: Your child is covered for emergencies and urgent care. No benefits are provided for services and/or supplies obtained without a HUGHP PCP referral except for emergency medical care and urgent care.
In the case of an emergency he or she should go to the nearest emergency room or call 911. If they require urgent care, (sore throats, earaches, and minor injuries) they should call their PCP for guidance. If they cannot call their PCP, and they receive urgent care for a medical condition, they must call their PCP or Member Services within 48 hours of receiving care. The reason for this is that urgent care requires a referral which will be created by your PKCP or Member Services to insure payment?
Q: Will my child be covered for mental health services while away at school?
A: Your child will be covered ONLY for emergency and urgent care while away at school. The provider will need to submit a “Behavioral Health Out-of Network Request Form” to Blue Cross Blue Shield of Massachusetts.
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Traveling Outside the HUGHP Service Area
Q: Am I covered when I’m traveling?
A: Yes. HUGHP covers medical emergencies (e.g. heart attack, stroke, loss of consciousness) anywhere in the world. Simply go to the nearest emergency room or call 911. For urgent care (sore throats, earaches, minor injuries), you should call your PCP for guidance. If you cannot call your PCP, you should seek treatment at the nearest appropriate health care facility and call your PCP or HUGHP Member services within 48 hours of receiving care.
Q: Am I covered when traveling outside the country?
A: Yes. You are covered for emergency and urgent care outside the United States.
- Members Call - Blue Card Worldwide Service Center -1.800.810.BLUE (2583) or collect -1.804.673.1177
- The Service Center will facilitate hospitalization at a Blue Card Worldwide hospital or make an appointment with a doctor. The Service Center is staffed with multilingual representatives and is available 24 hours a day, seven days a week.
Q: What if I paid for urgent/emergency care I received out of the country?
A: If you paid for services you must file your claim to the BlueCard Worldwide Service Center. (The BlueCard Worldwide International Claim Form is available on the HUGHP website under “Forms”.) The service center will prepare your claim. This includes: converting your bill to U.S. currency; and sending it to Blue Cross and Blue Shield for repayment to you.
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Behavioral Health Services (mental health or substance abuse)
Q: If I want to see a particular therapist and I am a HUGHP member, what do I need to do?
A: Under the HMO Plan, you may go on the BCBSMA website and click on the link “I am a member searching for a provider.” Go to “Find a provider by name” and follow the instructions. Your therapist must participate in the Managed Care Behavioral Health Network.
Q: I am already seeing a therapist through my current health plan. May I continue to see that therapist if I select HUGHP HMO?
A: If your provider is in the BCBS Managed Care Behavioral Health Network you may continue to see that provider. Review the BCBS website to be sure your provider is participating in the Managed Care Behavioral Health Network. BCBS has several different networks in which providers participate.
Q: If I have the HUGHP POS Plan and I’m seeing a provider who is non-participating in the BCBS Managed Care Behavioral Health Network, what will be my cost?
A: HUGHP will reimburse at 80% of the contracted rate, not the amount the provider charges. Your provider may balance bill you for the difference.
Q: May I use a behavioral health provider in the HUHS Mental Health Services Department?
A: HUGHP members are not eligible to receive care at HUHS unless they have had a longstanding relationship with an HUHS MH provider.
Q: Does HUGHP follow Mental Health parity? Are there limitations to the number of mental health visits I receive?
A: You will be covered for all medically necessary mental health care. As of January 1, 2010 a New Federal Law will be in place that requires mental health and substance abuse benefits have no more restrictive financial requirements or treatment limitations than are in place for or medical benefits. More information about medical necessity review requirements will be added to the website as they become known. Contact Member Services if you have questions.
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Medco Prescription Drug Benefits
Q: Does HUGHP have the same prescription benefit as Harvard Pilgrim Health Care? Are there any cost difference?
A: Please note that certain prescription drugs are on different tiers under HUGHP and HPHC. To calculate your exact costs on both premiums and prescription drugs, please use the Plan Compare tool referenced in the "2010 Benefits Open Enrollment Highlights" brochure mailed to your home.
Q: How does the Medco prescription drug benefit work under HUGHP?
A: HUGHP offers a three-tier drug benefit administered through Medco. Co-payments are for up to a 30 day supply:
Tier 1: $5
Tier 2: $15
Tier 3: $40
Q: Does HUGHP cover all prescription drugs?
A: There are some prescription drugs that are not covered. For information on drugs which are not covered go to the Medco website at www.Medco.com
Q: Which pharmacies can I use?
A: You can use any Medco participating pharmacy including the HUHS Pharmacy (if your prescription is written by an HUHS provider.) Most leading pharmacies participate in Medco (CVS, Rite Aid, Walgreens and other major chains).
Q: What if I need to get a prescription outside of Massachusetts?
A: If you are out of state and need to get a prescription, you can either contact Medco at 1-800-792-9503 or go on their website, www.Medco.com for help in finding a Network pharmacy in your current location.
Q: Can I get a 90 day supply of my prescription at any pharmacy?
A: You can only obtain a 90-day supply at the HUHS Pharmacy when your prescription is written by an HUHS provider, or through Medco mail order service. Note that 90 day supplies are not available for all prescriptions.
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HUGHP works with Blue Cross Blue Shield
Q: How do the two plans (HUGHP and BCBS) work together?
A: BCBS pays the claims of medical care providers on behalf of HUGHP. That means that BCBS reviews the claim against the HUGHP benefit to ensure that the service has been authorized by the member’s primary care provider (PCP) and the service is covered under the member’s benefit. BCBS credentials and contracts with all HUGHP/BCBS providers. BCBS administers the behavioral (mental health and substance abuse) health benefit by managing a network of providers called the Managed Care Behavioral Health Network.
In addition, BCBS offers discounts to HUGHP members for products and services plus access to on-line resources and tools.
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Referrals
Q: Can I see any one in the BCBS network?
A: HUGHP PCP’s refer their patients to specialists within their provider group. In some cases they will refer patients to BCBS (HMO Blue) doctors outside of their group whom they know to be highly qualified and with whom they work and consult regularly. This is something you will need to discuss with your PCP.
If you have specific questions about a specialist with whom you have an ongoing relationship, please contact HUGHP’s Member Services Department for more information.
Q: Can I see anyone in the BCBS network if I join the POS Plan?
A: Yes. The POS plan provides flexibility and allows you to go directly to a specialist WITHOUT a referral from your PCP. That visit, however, will be covered at the out-of-network level.
- You pay a $500 deductible per member in each calendar year ($2,000 family limit).
- After meeting your deductible, you pay 20% of the remaining covered charges. This is your co-insurance.
- Your out-of-network provider may bill you the difference between his/her charge for services and the amount the HUGHP POS pays for those particular services.
- You are protected by an out-of-pocket maximum. Your co-insurance annual out-of-pocket maximum is $2,000 ($5,000 family limit). Keep in mind, the out-of-pocket maximum does not include amounts you pay toward your annual deductible. When you reach your out-of-pocket maximum, most covered services will be paid in full.
Q: If I am considering HUGHP but have an existing relationship with a specialist, may I continue to see that specialist?
A: It is possible that your new PCP will ask that you shift your care to a specialist he or she works with on a regular basis to facilitate communication and care coordination. This is something you will need to discuss with your new PCP. Contact HUGHP Member Services for more information.
Q: Am I restricted to using the HUHS OB-GYN group for maternity care or my annual exams?
A: No. You can use any HMO Blue OB-Gyn provider. The coverage is the same whether you use a HUHS provider or HMO Blue provider for OB-Gyn care. To find a provider in the HMO Blue network, go to the BCBSMA website and click on the link “I am a member searching for a provider.” Go to “Find a provider by name” or “by specialty” and follow the instructions. If you need assistance, contact Member Services at 617-495-2008 or Mservices@huhs.harvard.edu.
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Fitness and Weight Loss Benefits
Q: Does HUGHP offer a fitness benefit?
A: Yes. The HUGHP Fitness Benefit provides up to $150 that you or your family may use toward membership or exercise classes at a qualified health club.
Q: What kind of health club membership qualifies?
- The facility you choose must have a vast array of cardiovascular and strength-training exercise equipment, such as traditional health clubs, YMCAs/YWCAs, and JCCs. Fees paid for attending aerobics/fitness classes at a qualified health club without an annual membership will also be covered, but make sure you get full documentation from the club.
- Health clubs that do not qualify include: martial arts centers, gymnastics facilities, country clubs, tennis, aerobic, or pool-only facilities, social clubs, sports teams & leagues.
- Dues or fees for participation in aerobic/fitness activities not in a qualified health club, as well as fees for personal training, lessons, coaching, and exercise equipment or clothing purchases, will not be covered.
Q: What is the weight loss benefit?
A: HUGHP members are eligible for a Weight Loss Benefit that can save you or your family up to $150 per calendar year in qualified weight loss program fees. A member can claim the Weight Loss Benefit once he or she has paid for the program. Qualified programs include traditional Weight Watchers™ meetings, the Weight Watchers™ At Work program, and hospital-based weight loss programs.
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Additional Healthy HUGHP Discounts
- Discount on Mind/Body Classes. Learn skills and techniques to manage and reduce symptoms of chronic illness and/or stress and receive 50% off these programs.
- HUHS Center for Wellness Discounts of up to 50%. Complementary therapies such as acupuncture, Reiki, and massage are only $40 for an hour long treatment; exercise classes including Pilates and yoga; CPR and safety courses; educational workshops; and more are offered at 50% off. Services are offered year-round, seven days a week, including evenings and weekends.
- Receive Wellness Calendar Updates. Email updates on health education events, lectures, discussions, and activities at HUHS and in the community.
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